经跗骨窦扩大入路钢板内固定治疗跟骨骨折
摘要
目的探讨经跗骨窦扩大入路钢板内固定治疗跟骨骨折的临床疗效。方法回顾性分析自2015-01—2016-12采用经跗骨窦扩大入路钢板内固定治疗的跟骨关节内骨折42例(46足),分析术后放射学结果、疼痛VAS评分、AOFAS踝-后足功能评分,并记录并发症情况。结果本组所有患者均获得随访,随访时间平均20.4(12～30)个月。骨折平均愈合时间12周。术后SandersⅡ型骨折(28足)关节面均达到解剖或接近解剖复位;SandersⅢ型骨折中,14足关节面达到解剖或接近解剖复位,4足关节面移位2～4 mm。术后即刻与末次随访时Bohler角分别为14°～38°(26.9±5.2)°和12°～38°(26.5±5.0)°,差异无统计学意义。末次随访时疼痛VAS评分为0～2(0.6±0.3)分,AOFAS踝-后足功能评分:优27足,良15足,可4足,优良率91.3%。36例恢复受伤前工作或活动水平。结论经跗骨窦扩大入路钢板内固定治疗跟骨骨折能够取得满意的临床疗效,伤口并发症少见,是微创治疗SandersⅡ、Ⅲ型跟骨关节内骨折的良好选择。
引文
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[4]张宏伟,张敬堂,刘思杰.经跗骨窦入路手术治疗SandersⅡ、Ⅲ型跟骨骨折的临床研究[J].中国骨与关节损伤杂志,2018,33(8):879-881.
[5]王向前,张计超,李军,等.3D打印技术辅助跗骨窦入路钢板内固定治疗SandersⅡ、Ⅲ型跟骨骨折[J].中国骨与关节损伤杂志,2018,33(8):881-883.
[6]Hsu AR,Anderson RB,Cohen BE.Advances in surgical management of intra-articular calcaneus fractures[J].J Am Acad Orthop Surg,2015,23(7):399-407.
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[9]Xia S,Lu Y,Wang H,et al.Open reduction and internal fixation with conventional plate via L-shaped lateral approach versus internal fixation with percutaneous plate via a sinus tarsi approach for calcaneal fractures-a randomized controlled trial[J].Int J Surg,2014,12(5):475-480.
[10]Zhang T,Su Y,Chen W,et al.Displaced intra-articular calcaneal fractures treated in a minimally invasive fashion:longitudinal approach versus sinus tarsi approach[J].J Bone Joint Surg Am,2014,96(4):302-309.
[11]Meng Q,Wang Q,Wu X,et al.Clinical application of the sinus tarsi approach in the treatment of intra-articular calcaneal fracture[J].Medicine(Baltimore),2018,97(13):e0175.
[12]Rawicki N,Wyatt R,Kusnezov N,et al.High incidence of post-operative infection after‘sinus tarsi’approach for treatment of intraarticular fractures of the calcaneus:a 5 year experience in an academic level one trauma center[J].Patient Saf Surg,2015,9:25.
[13]Park CH,Yoon DH.Role of subtalar arthroscopy in operative treatment of sanders type 2 calcaneal fractures using a sinus tarsi approach[J].Foot Ankle Int,2018,39(4):443-449.
[2]Rammelt S,Zwipp H,Schneiders W,et al.Severity of injury predicts subsequent function in surgically treated displaced intraarticular calcaneal fractures[J].Clin Orthop Relat Res,2013,471(9):2885-2898.
[3]Kline AJ,Anderson RB,Davis WH,et al.Minimally invasive technique versus an extensile lateral approach for intra-articular calcaneal fractures[J].Foot Ankle Int,2013,34(6):773-780.
[4]张宏伟,张敬堂,刘思杰.经跗骨窦入路手术治疗SandersⅡ、Ⅲ型跟骨骨折的临床研究[J].中国骨与关节损伤杂志,2018,33(8):879-881.
[5]王向前,张计超,李军,等.3D打印技术辅助跗骨窦入路钢板内固定治疗SandersⅡ、Ⅲ型跟骨骨折[J].中国骨与关节损伤杂志,2018,33(8):881-883.
[6]Hsu AR,Anderson RB,Cohen BE.Advances in surgical management of intra-articular calcaneus fractures[J].J Am Acad Orthop Surg,2015,23(7):399-407.
[7]Turner NM,Van de Leemput AJ,Draaisma JM,et al.Validity of the visual analogue scale as an instrument to measure self-efficacy in resuscitation skills[J].Med Educ,2008,42(5):503-511.
[8]Kitaoka HB,Alexander IJ,Adelaar RS,et al.Clinical rating systems for the ankle-hindfoot,midfoot,hallux and lesser toes[J].Foot Ankle Int,1994,15(7):349-353.
[9]Xia S,Lu Y,Wang H,et al.Open reduction and internal fixation with conventional plate via L-shaped lateral approach versus internal fixation with percutaneous plate via a sinus tarsi approach for calcaneal fractures-a randomized controlled trial[J].Int J Surg,2014,12(5):475-480.
[10]Zhang T,Su Y,Chen W,et al.Displaced intra-articular calcaneal fractures treated in a minimally invasive fashion:longitudinal approach versus sinus tarsi approach[J].J Bone Joint Surg Am,2014,96(4):302-309.
[11]Meng Q,Wang Q,Wu X,et al.Clinical application of the sinus tarsi approach in the treatment of intra-articular calcaneal fracture[J].Medicine(Baltimore),2018,97(13):e0175.
[12]Rawicki N,Wyatt R,Kusnezov N,et al.High incidence of post-operative infection after‘sinus tarsi’approach for treatment of intraarticular fractures of the calcaneus:a 5 year experience in an academic level one trauma center[J].Patient Saf Surg,2015,9:25.
[13]Park CH,Yoon DH.Role of subtalar arthroscopy in operative treatment of sanders type 2 calcaneal fractures using a sinus tarsi approach[J].Foot Ankle Int,2018,39(4):443-449.